Physicians Practice - February 2008 - (Page 14)

LETTERS nor will I ever. I do know that I'm not being paid whatever I earn. Imagine, in any other business, signing a contract to be paid a salary but the employer pays you less. It would be clear you were not being paid “enough.” That is exactly what happens to physicians every day. Insurers ﬁnd every loophole to deny payment and know that nearly 10 percent of what they should pay will go unclaimed. Now, factor in insurers’ contracts tied to Medicare (which either stays constant or decreases yearly), our inability to bargain as a union while insurers bully us into 2. Doctors in these countries don’t have nearly (if any) of the overhead that we do nor the astronomical malpractice premiums that we do because of our out-of-control tort system. 3. Doctors in these countries know the deal going in. In the U.S., we have already paid our dues, paid for our educations, our malpractice, gone through college, medical school, residencies, and fellowships — and having done all of this, now there is talk of governmental control of medicine, and we’ll just have to take what the government will give us. If Medicare/ Medicaid is any guide then that won’t If, today, a U.S. grad spends four years in pre-med (which is not required in a lot of other countries) and then med school and residency with huge costs (about $200,000 at Mount Sinai where I did my training), he ought to be making more money to pay back all the student loans. Otherwise he will be in debt for life and it just won’t be worth it. —Rajat Bhatt, MD Assistant Professor, Internal Medicine Texas Tech University Lubbock, Texas There were excellent points made in “How Much Is Enough?” I’m an older internist who works for the VA and played a role in turning the VA into a more primary-care based system. Early in my career, one of my mentors pointed out that salary is only one factor in a job. Location, quality of life, afﬁliation (with other members of the organization), security, sense of mission, intellectual challenge, and other factors also loom large. My mentor felt salary was a threshold issue — one had to meet a certain threshold, but, beyond that, the other factors became important. But one factor in being satisﬁed with salary is simply being satisﬁed with your salary. More is always nicer, but if you meet your needs, at whatever level, and are happy with the salary you have, then you are satisﬁed. One cause of dissatisfaction for primary care is looking at our colleagues in specialties such as radiology and orthopedics. Primary-care physicians likely work more hours in less controlled circumstances, yet make considerably less. —David Lee, MD Boise, Idaho I was dismayed that your article focused solely on physician income while ignoring other aspects of medical practice that severely limit physician satisfaction — the lack of autonomy for physicians and patients to make decisions. We should not be envious of those making more than we do. There are many people who make far, far more than I do, and I wouldn’t trade WWW.PHYSICIANSPRACTICE.COM “ENOUGH”? HARDLY “Although it is not true that whoever dies with the most money ‘wins,’ it is very dejecting to see people with a fraction of my education, training time, and work hours pulling down millions a year.” be much and in many cases will be less than the actual cost of providing care. In short, doctors in those countries have less time and much less money invested in becoming doctors, little to no overhead, and a totally different tort system than we do. If U.S. doctors made 1.4 times the average worker’s salary ($37,500/year) they couldn’t even pay their insurance premiums. —Ronald Bank, MD Vienna, Va. While I agree with your statement in “How Much Is Enough” about the perpetual unhappiness of doctors, I do not agree with the measures you mentioned regarding other countries. The fact that a doctor in the U.K. makes 1.4 times the average U.K. resident has a lot to do with the cost of medical school and other training. The National Health Service in Britain employs a bunch of foreign-trained doctors and thus there is no cost of medical school involved in the equation. accepting whatever they decide to pay, our employees’ demands of costof-living increases, and a host of other factors, and you’ll see that we are not paid enough. —Steven Fass, MD Austin, Texas I read “How Much Is Enough?” with some dismay, as this is the kind of article that comes back to bite us courtesy of those pushing a single-payer, European style, socialized healthcare system. A few thoughts to consider when looking at the compensation of U.S. physicians versus those in the other industrialized nations mentioned in the column: 1. In most, if not all of those countries, the path to become a physician is shorter, either entering a six-year medical school directly from high school or something similar, and the education is usually free. Thus these doctors do not graduate with the six-ﬁgure debt that we do. 14 | PHYSICIANS PRACTICE | FEBRUARY 2008 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - February 2008

Physicians Practice - February 2008 Contents The Bigger Picture: Your Future is in Your Hands Letters Physicians Practice Pearls: Creating an A+ Practice Noteworthy Cover Story: Conquering Time: 5 Keys to a More Efficient Practice In Balance: A Family Affair Technology: Making EMRs Work in the Exam Room In Practice: "I've Got Some Bad News" The Tech Doctor - The EMR: Savior or Poseur? Ask the Experts NEW! Healthonomics: How to Handle Health Savings Accounts The Administrator's Desk: Finishing School for New Managers Human Resources: Is Your Partner Impaired The Great Practice Makeover: Too Well-Liked for His Own Good? Coding Idealab: 'Why I Blog' Classifieds Advertiser Index

Physicians Practice - February 2008

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